Intra-abdominal abscess

There are no preventive strategies for primary IAA (i.e., related to perforated appendicitis and diverticulitis). One Cochrane review examined the effect of abdominal drainage on the prevention of intraperitoneal abscesses after open appendectomy for complicated appendicitis. The effectiveness of abdominal drainage was unclear, and the evidence was of low certainty. Abdominal drainage may increase the 30-day complication rate and length of hospital stay; larger studies are needed to more reliably determine the effects of drainage on morbidity and mortality outcomes.[17]Li Z, Li Z, Zhao L, et al. Abdominal drainage to prevent intra-peritoneal abscess after appendectomy for complicated appendicitis. Cochrane Database Syst Rev. 2021 Aug 17;(8):CD010168. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010168.pub4/full http://www.ncbi.nlm.nih.gov/pubmed/34402522?tool=bestpractice.com  There is no evidence from randomized controlled trials to confirm or refute the use of prophylactic antibiotics for penetrating abdominal trauma.[18]Brand M, Grieve A. Prophylactic antibiotics for penetrating abdominal trauma. Cochrane Database Syst Rev. 2019 Dec 12;(12):CD007370. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6907398 http://www.ncbi.nlm.nih.gov/pubmed/31830316?tool=bestpractice.com For patients with secondary IAA (i.e., postoperative or related to spread through bacteremia), potential strategies for prevention of IAA include adequate source control of the initial complicated intra-abdominal infection and early initiation of appropriate empiric antimicrobial therapy.

The host response to intra-abdominal infection depends on five key factors: 1) inoculum size, 2) virulence of the contaminating organisms, 3) presence of adjuvants within the peritoneal cavity, 4) adequacy of local, regional, and systemic host defenses, and 5) adequacy of initial treatment (i.e., source control). Patients are at higher risk of IAA formation after treatment of intra-abdominal infection if any of these key factors are not adequately treated.

Sound surgical technique and compliance with all standard sterile measures during surgery may decrease risk of postoperative IAA. Appropriate preoperative antimicrobial therapy as indicated by the procedure is a critical step in preventing postoperative infections.